To assess safety and reliability of catheter removal 5-days after Vapor Therapy Rezum (VTR)
procedure for benign prostatic hyperplasia (BPH).

This was a prospective randomized trial held in our department between 2023-2025. Males
undergoing VTR for BPH were randomized into Group A (GA), catheter removal 5-days after
surgery, Group B (GB), catheter removal >7 days. Urinary retention (UR) episodes, discomfort/pain
at micturition in the first week after catheter removal were recorded with VAS, PGII, post-void urine
residual (PVR). The 1 and 3-mos follow-up included uroflowmetry with PVR, VAS for
pain/discomfort, PGII, IPSS, QoL, OAB screener, IIEF-5, MSHQ questionnaires. The reason for a
short f-up was that main adverse events related to shorter postoperative catheterization usually
occur in the first few months.

Data were available on 124 males: 52 GA and 72 GB (mean age 66.4 y.o). In GA UR rate was
3.8%, in GB 6.9% (p:0.02), all episodes resolved in the first month. The discomfort amount in GA
was significantly lower than in GB (p:0.01). At 1 mos f-up, no statistical differences were found
between groups in IPSS (GA 12 vs GB 14, p:0.8), QoL (GA 3 vs GB 2.7, p:0.5), OAB screener (GA
29.3 vs GB 33.6, p:0.2), IIEF 5 (GA 10.4 vs GB 10.2, p:0.7), Qmax (GA 12.3 vs GB 12.5, p0.9),
PVR (GA 26.6ml vs GB 36.7 ml, p: 0.4), VAS discomfort/pain (GA 1.12 vs GB 1.14, p:0.9), PGII
(GA 2.5 vs GB 2.7, p:0.5), MSHQ-A (GA 9.7 vs GB 9.3, p:0.4), MSHQ-BH (GA 1.5 vs GB 1.9,
p:0.2). At 3-months f-up, statistical difference was achieved in OAB screener (GA 23.6 vs GB 31.5,
p:0.02), while no significant difference was found in IPSS (GA 7.4 vs GB 11, p:0.07), QoL (GA 1.6
vs GB 2.2, p:0.2), IIEF (GA 13 vs 12.5, p:0.5), Qmax (15.1 vs GB 14.5, p:0.3), PVR (GA 10ml vs
GB 23.6ml, p:0.2), VAS discomfort/pain (GA 0.75 vs GB 0.72, p:0.4), PGII (GA 2.3 vs GB 2.5,
p:0.9), MSHQ-A (GA 11.1 vs GB 9.8, p:0.2), MSHQ-BH (GA 1 vs GB 1.9, p:0.05).

To date, catheter removal time after VTR have not yet been standardized. Concerns about a
shorter duration of postoperative catheterization are related to inflammation of the prostate, which
may cause discomfort/pain, voiding dysfunction, storage symptoms, UR .Our data showed that
catheter removal at 5 days was safe and did not increased risk of immediate adverse events, nor
at 1 and 3 -mos follow-up, and did not negatively influence surgical results. Although the rate of
immediate UR was significantly higher in case of early catheter removal, this condition was
transient in all cases. Storage symptoms rate was not higher when catheter was removed early.
Even bothersome symptoms and pain were similar in the two groups. Therefore, a longer
catheterization time was not a protective factor for these symptoms. VTR is a minimally invasive
surgical therapy, aimed to reduce invasiveness. A long period of postoperative catheterization may
be opposite to the concept of minimally invasiveness and perceived by the patient as an obstacle to performing this procedure. Moreover, a longer duration of catheterization is a discomfort factor
for the patient negatively influencing the post-operative period. So, it is desirable to shorten the
post-operative catheterization.

Our data demonstrated that 5 days may represent a safe and adequate period of catheterization
after VTR because it does not increase the risk of adverse events and does not negatively impact
surgical outcomes.

Continence 19S (2026) 102715
DOI: 10.1016/j.cont.2026.102715